Overview Of Adult Viral Infxs

Front 1

host defenses

Back 1

-nonspecific barriers skin, resp epithelium, gastric acidity
-antiviral AB
-cell mediated immunity- cytotoxic T cells
-proliferation of macrophages that restrict viral replication and dissemination and destroy infected cells

Front 2

the viral illness

Back 2

-local infx
-dissemination via hematogenous, lymphatic or neuronal to distant sites
-viral replication in the secondary site produces viremia that results in replication in other sites

Front 3

common cold

Back 3

-acute, self-limited
-sx: rhinorrhea, nasal obstruction, sore throat, cough
-transmitted by direct contact
-rhinovirus, coronovirus
-slightly red nasal mucosa, mildly erythematous pharyngeal area
-fever uncommon
-tx: symptomatic

Front 4

complications of common cold

Back 4

1. secondary bacterial infxs:
-kids: suppurative OM
-adults: sinusitis
2. bacterial PNA very uncommon

Front 5

Influenza

Back 5

-acute, febrile resp illness
-highly contagious
-prominent systemic sx early in illness
-family: orthomyxoviridaw
-3 types: A,B,C

Front 6

flu- Epidemiology and Antigenic Variation

Back 6

-changing antigenicity surface glycoprotein accounts in part for epidemics
-antibody to HA: neutralizes viral infectivity, major determinant of immunity
-antibody to NA: limits viral replication, limits severity of infection
-minor and major antigenic drift/shift

Front 7

flu- pathology

Back 7

-transmission: person to person
-incubation: 2 days
-durations: 3-5 days
-rarely viremia
-nsal and bronchial bx: desquamation of the ciliated columnar epithelium, lungs may show hemorrhage
-secondary bacterial infx can occur

Front 8

flu- immunity

Back 8

-ABs beging to develop second wk after infx and reach a peak by 4 wks
-Immunity against influenza is subtype specific and durable

Front 9

flu- clinical features

Back 9

-abrupt onset of fever, chills, HA, myalgias and malaise
-as systemic symptoms diminish, respiratory complaints and findings become more apparent. Cough is the most frequent ant troublesome.
-fever most impt initial physical finding
-women experience inc complications of flu in the 2nd and 3rd trimester of preg

Front 10

flu complications

Back 10

1. primary influenza viral PNA
2. secondary bacterial PNA
3. mixed viral and bacterial PNA

Front 11

flu dx and tx

Back 11

-mostly clinical
-readily isolated from the throat or nasal specimens, sputum or tracheal secretion specimens in the first 2-3days of illness
-rapid detection tests
-oseltamivir
-zanamivir

Front 12

herpesviruses

Back 12

-8 identifiedL HSV 1 and 2, varicella-zoster, EPV, CMV, roseola, kaposis sarcoma

Front 13

HSV clinical findings

Back 13

-mucocitaneous dz
-ocular dz
-neonatal and congenital infx
-encephalitis and recurrent meningitis
-disseminated infx
-bell's palsy (facial nerve paralysis)
-esophagitis
-erythema multiforme

Front 14

HSV 1

Back 14

-primarily involves mouth and oral cavity' "herpes labialis"
-herpetic whitlows
-minority of urogenital infxs
-vesicles form moist ulcers--> epithelialize over 1-2 wks
-primary infx may be asymptomatic
-recurrences are often milder, fewer lesions, heal fasted, induced by stress, fever, infx, sunlight

Front 15

HSV 2

Back 15

-vesicles similar to HSV 1
-genital tract
-lesions are multiple, painful, small, grouped and vesicular
-may have assoc LAD
-a manifestation of primary infx in women may be aseptic meningitis
-asymptomatic shedding is common

Front 16

HSV ocular dz

Back 16

-HSV 1 can cause keratitis, blepharitis, keratoconjunctivitis
-Keratitis: usually unilat, impaired visual acuity; dx by dendritic ulcers that stain with flurescein
-avoid steroids in eye!!!

Front 17

HSV encephalitis

Back 17

-HSV 1 is the causitive agent
-present with non-specific sx, flu-like prodrome, followed by HA, fever, behavior and speech disturbances and seizures
-propensity to involve temporal lobes

Front 18

HSV encephalitis- CSF

Back 18

-white cell pleocytosis is common
-HSV DNA PCR in the CSF is a rapid and sensitive and specific tool for early dx and is rapidly replacing brain bx as the diagnostic standard

Front 19

HSV meningitis

Back 19

-HSV 2 has been implicated as a major cause of benign recurrent lymphocytic meningitis

Front 20

HSV disseminated infx0

Back 20

-occurs in the setting of immunosuppression
-skin lesions not always present

Front 21

HSV ensophagitis

Back 21

-HSC 1 in AIDs pts and other IC pts
-dz by endoscopic bx and cx
-distinguished from CMV esophagitis in the size and depth of lesions (smaller and deeper)

Front 22

erythemia multiforme

Back 22

-HSV is assoc with erythema multiforme and with the more severe, mucosally involved SJS
-also assoc with drugs, infx and mycoplasma

Front 23

HSV and neonatal and congenital infx

Back 23

-can infect the fetus and induce congenital malformations
-neonatal herpes may also occur form unrecognized shedding in the moms genital tract at the time of delivery

Front 24

HSV dx and tx

Back 24

-usually made clinically
-viral cx of vesicular fluid
-Tzanck prep - intranuclear inclusion bodies and multinucleated giant cells
-direct fluroescent AB staining of scraped lesions
-can be identified in serum using PCR
-tx: acyclovir, valacyclovir, famciclovir

Front 25

varicella-zoster virus

Back 25

-dz manifestations: chicken pox, shingles
-exposure 14-21 days before onset
-fever and malaise just before or w/eruption
-rash: pruritic, centrifugal, papular, changing to vesicular, pustular and finally crusting

Front 26

varicella- clinical findings

Back 26

-fever and malaise
-vesicular lesions > rupture to form small ulcers
-may first appear in oropharynx
-pruritic rash, beginning on face, scalp, trunk
-reactivation later in life is manifested as herpes zoster

Front 27

varicella- complications

Back 27

-secondary bacterial infxs; S.pyogenes
-interstitial PNA > ARDS
-ischemic strokes
-hepatitis
-encephalitis
-Reye's syndrome - fatty liver with encephalopathy
-congenital malformations when contract during the 1st or 2nd trimesters
-if a mom develops varicella within 5 days after delivery, the newborn is at risk for disseminated disease and should receive VZIG

Front 28

herpes zoster complications

Back 28

-in IC and HIC pts, zoster may produce skin lesions beyond the dermatome, visceral lesions and encephalitis
-post-herpetic neuralgias occur in 50% of zoster pts >60

Front 29

herpes zoster- clinical findings

Back 29

-severe pain, may precede the rash
-lesions follow nerve root
-single, unilat dermatome involvement
-multidermatomal involvement is seen in IC
-lesions on the tip of the nose indicates involvement of V1
-geniculate ganglion involvement (ramsey hunt syndrome)

Front 30

zoster dx and tx

Back 30

-clinical
-direct immunofluorescent AB staining
-Tzanck smear
-tx: acyclovir, famciclovir, valacyclovir; secondary bacterial infxx > topical mupiricin +/- oral antistaph abx

Front 31

zoster ocular involvement

Back 31

-ophth referral
-mydriatics
-antivirals
-topical steroids (caution)

Front 32

infectious mono

Back 32

-EBV, transmission by saliva
-malaise, fever, sore throat
-LAD, splenomegaly, maculopap rash
-positive heterophile agglutination test
-atypical large lymphocytes in blood smear; lymphocytosis
-complications: LAD, HSM, hepatitis, thrombocytopenia

Front 33

mono clinical features

Back 33

-fever, sore throat, malise, anorexia, myalgia
-LAD, splenomegaly (no contact sports for 4-6wks)
-hepatitis, myocarditis, pul involvement
-neur involvment: aseptic meningitis, encephalitis, Guillain-Barre syndrome
-airway obstruction from LN enlargement

Front 34

mono- complications

Back 34

-secondary bacterial throat infxs
-splenic rupture
-pericarditis, myocarditis
-encephalitis
-guillain-barre syndrome

Front 35

mono dx and tx

Back 35

-clinical
-heterophile AB test, monospot test usually becomes positive within 4 wks after onset of illness
-tx: none specific, steroids, supportive

Front 36

other EBV syndromes

Back 36

-EBV viral antigens have been found in over 90% of pts with African Burkitt's lymphoma or nasopharyngeal carcinoma
-B cell lymphomas
-oral hairy leukoplakia

Front 37

cytomegalovirus

Back 37

-mostly asymptomatic
-seroprevalence inc with age and sexual contact
-transmission is sexual, congenital, through blood products or transplant and person-to-person
-severe dz occurs primarily in the IC pts

Front 38

CMV clinical findings

Back 38

3 recognizable clinical syndromeS:
1. perinatal dz: CNS calcifications, HSM, mental retardation
2. Acute acquired infx: fever, malaise, myalgias, splenomegaly (mono-like symtoms, heterophile negative)
3. disease in immunocompromised hosts - BMT patients are at increased risk in the first 100 days following allograft transplantation

Front 39

CMV dz in IC hosts

Back 39

-CMV retinitis
-GI and hepatobiliary CMV
-pul CMV
-neuro CMV

Front 40

CMV dx and tx

Back 40

-viral cx
-tzanck smear
-tx: foscarnet, ganciclovir, cidofovir, HAART

Front 41

HHV -6

Back 41

-principal cause of exanthma subitum
-primarily seen in kids under age 2
-most common cause of febrile seizures
-HHV 6 in adults is associated with immunocompromised states such as HIV and lymphoma; encephalitis and pneumonitis in AIDS

Front 42

HHV-7

Back 42

-assoc with roseola

Front 43

HHV-8

Back 43

-assoc with kaposi's sarcoma in AIDS